title: Airflow limitation in smokers is associated with subclinical atherosclerosis.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality from cardiovascular disease. Although a close association between COPD and atherosclerosis has been speculated, such scientific information is limited.
  
  
  OBJECTIVE
  To evaluate subclinical atherosclerosis in smokers with airflow limitation.
  
  
  METHODS
  The subjects of this study were healthy middle-aged men. Smokers with airflow limitation (n = 61) and age-matched control smokers (n = 122) and control never-smokers (n = 122) without airflow limitation were included in the present study. Subjects with diabetes, acute infection, and respiratory disease other than COPD were excluded beforehand. All subjects underwent chest radiogram, spirometry, blood sampling, and carotid ultrasonography. We determined carotid intima-media thickness and focal atheromatous plaque as indicators of subclinical atherosclerosis.
  
  
  RESULTS
  Mean carotid intima-media thickness was greater in smokers with airflow limitation than in control smokers (P < 0.01) and control never-smokers (P < 0.005). Focal carotid plaque was significantly more prevalent in smokers with airflow limitation than in control never-smokers (P < 0.005). Multivariate analyses showed significant associations between thickened intima-media thickness and decreased percent predicted FEV(1) (P = 0.001) and between plaque and log(10) C-reactive protein (P = 0.013) independent of age, pack-years of smoking, body mass index, peripheral mean arterial pressure, heart rate, glucose, and low-density lipoprotein cholesterol.
  
  
  CONCLUSIONS
  Smokers with airflow limitation had exaggerated subclinical atherosclerosis. This study suggests that middle-aged men who are susceptible to COPD may also be susceptible to vascular atherosclerosis by smoking, and atherosclerotic change starts early in the disease process of COPD.
authors.affiliation: Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iwamoto
authors.forename: Akihito
authors.initials: A
authors.lastname: Yokoyama
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kitahara
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Ishikawa
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Haruta
authors.forename: Kiminori
authors.initials: K
authors.lastname: Yamane
authors.forename: Noboru
authors.initials: N
authors.lastname: Hattori
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hara
authors.forename: Nobuoki
authors.initials: N
authors.lastname: Kohno
mesh_terms: D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000453:epidemiology* / Q000503:physiopathology; D016022:Case-Control Studies; D004198:Disease Susceptibility / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000503:physiopathology*; D012907:Smoking / Q000453:epidemiology* / Q000503:physiopathology*; D014463:Ultrasonography